Interprofessional What is Reflection?
• Reflection is an iterative process that occurs before, during and after situations with the purpose of developing greater understanding of both the self and the situation so that future encounters with the situation are informed by previous encounters”1.
How does Reflection apply to Interprofessional Teams?
• Different approaches to build skill in reflective practice include written processes (journaling, narrative writing, structured reflection with prompts), and oral processes (debriefing).
The high stakes nature of health care combined with the diversity of training, personal background and professional perspective among interprofessional team members demands an ongoing process to navigate differences and improve processes. The process of reflection can enhance team functioning in two ways: • Individual team members reflect on their professional contribution within the team and their role in team process
• Initially, reflection may feel awkward as reflection is not necessarily intuitive2 though practice over time can help to develop the reflective habit of mind necessary for competent professional practice.
• The team as a whole may discuss and reflect on their individual and collective performance with respect to an event while incorporating feedback from outside sources and making plans for improved performance. While individual reflection is valuable, it is not sufficient to effect change on a team level; intentional analysis by all team members is necessary for workable change.
Why Reflect?
As an essential process for professional self-assessment and practice improvement, reflection • Helps with integration of feedback , identification of one’s own strengths and limitations, and then the pursuit of information or outside expertise needed to improve practice . • Can improve quality of care through increased diagnostic accuracy4, and reduced medical errors3. • Focuses attention on team process, thus managing conflict that can impact team function and job satisfaction.
Levels of Reflection Describe the event, issue or situation Personal / Team Analysis
How do you and/or your team interpret the event?
Context
Practice Implications
Use your analysis to identify learning needs or changes to practice
How to use this guide
This guide can be used as a step-by-step guide to personal, professional and interprofessional reflection. • Reflection does not need to be formulaic in order to be effective, as long as the description, analysis and practice implications are present. • Successful written reflections may begin with a description of the event as a foundation for analysis, though need not follow the remaining steps in a linear way.
Questions That Guide Reflection
Answering all of the questions is not necessary, or even desirable, in a single reflection.
What happened? What was your professional and team role in the event? How did other team members contribute, including the patient and/or family? What was your emotional response to the event? Other team members? How does the event relate to your personal ethics or values? Other team members? What expectations/assumptions did you/your team have? Were they confirmed or challenged? What were your personal or professional strengths and/or limitations in relation to the event? Other team members? What other factors may have affected the event? How does your interpretation align with external sources like • Feedback from patients, community members, facilitators, team members or peers? • The literature? • Your profession’s standards of practice or code of ethics? What organizational, historical or sociological implications does the event have? What implications does the event have for your future practice? What knowledge or expertise is needed to support your future practice? How will you acquire that knowledge or access expertise? How will you approach a similar event in the future? Any factors from this experience that remain uncertain? How might you grapple with these grey issues going forward?
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References Sandars, J. (2009). The use of reflection in medical education: AMEE Guide No. 44. Medical Teacher, 31(8), 685-695. Wald, H. S., & Reis, S. P. (2010). Beyond the margins: Reflective writing and development of reflective capacity in medical education. Journal of General Internal Medicine, 25(7), 746-749. 3 Eva, K. W., & Regehr, G. (2005). Self-Assessment in the health professions: A reformulation and research agenda. Academic Medicine., 80, S46-S54. 4 Mann, K. V. (2008). Reflection: understanding its influence on practice. Medical Education, 42(5), 449-451. 1 2
This guide was developed by members of the HSERC Working Committee. We wish to acknowledge Dr. Hedy Wald for her input in the revision of this guide.
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